Tuesday, August 2, 2011

How do YOU do Dissociation?

Wow! Where did I just go?
Its been almost ten months since a particularly brutal experience of rejection with my oldest son. I remember walking around for hours draining the energies of anger and rage the encounter stimulated. I did my best to avoid amplifying those negative emotions by not replaying the episode in my mind. A few months later though when I tried to recall details and write about the family dynamics involved, a foggy sensation filled my mind as numbness overcame my senses. Only in the last week have I been able to face the memories with any clarity of mind and emotional recollection of that day.


What exactly is Dissociation?

Evolution has equipped us with some magical powers of pain defense, with automatic dissociation one of those mysterious affects often labeled as a symptom of mental illness. Yet when the same powers within the human nervous system are employed to positive effect, like self hypnotized analgesia to avoid pain, the only label we find is a wondrous Wow! Of admiration. As I wrote in the article meaning and mania, during my therapist training, I sat in stunned silence watching video footage of a 65 year lady with a history of bad reactions to anesthesia, lie calm and relaxed through a major operation, using only self hypnosis for pain control.

In the same article I talked about the hidden, unconscious power of our autonomic nervous system and its denied role in mental illness symptoms. We are indeed a curious creature, hard wired for external observation, with a peculiar resistance to awareness of what goes on beneath the conscious mind? Our knowledge of symptomatic mental anguish and its presumption of illness are by enlarge, external observations of behaviors and the minds assumptive perception. Consider typical descriptions of dissociation we find on the internet and in published medical literature.

Dissociation as a Mental Illness?
The DSM-IV considers symptoms such as depersonalization, derealization and psychogenic amnesia to be core features of dissociative disorders. However, in the normal population dissociative experiences that are not clinically significant are highly prevalent, with 60% to 65% of the respondents indicating that they have had some dissociative experiences.

Relation to trauma and abuse.
Dissociation has been described as one of a constellation of symptoms experienced by some victims of multiple forms of childhood trauma, including physical, psychological, and sexual abuse. This is supported by studies which suggest that dissociation is correlated with a history of trauma. Dissociation appears to have a high specificity and a low sensitivity to having a self-reported history of trauma, which means that dissociation is much more common among those who are traumatized, yet at the same time there are many persons who have suffered from trauma but who do not show dissociative symptoms.

Adult dissociation when comorbid with a history of child abuse and otherwise interpersonal violence-related posttraumatic stress disorder (PTSD) has been shown to contribute to disturbances in parenting behavior, such as exposure of young children to violent media. Such behavior may contribute to cycles of familial violence and trauma.

Symptoms of dissociation resulting from trauma may include depersonalization, psychological numbing, disengagement, or amnesia regarding the events of the abuse. It has been hypothesized that dissociation may provide a temporarily effective defense mechanism in cases of severe trauma; however, in the long term, dissociation is associated with decreased psychological functioning and adjustment.

Other symptoms sometimes found along with dissociation in victims of traumatic abuse (often referred to as "sequelae to abuse") include anxiety, PTSD, low self-esteem, somatization, depression, chronic pain, interpersonal dysfunction, substance abuse, self-mutilation and suicidal ideation or actions. These symptoms may lead the victim to erroneously present the symptoms as the source of the problem.

Child abuse, especially chronic abuse starting at early ages, has been related to high levels of dissociative symptoms in a clinical sample, including amnesia for abuse memories. A non-clinical sample of adult women linked increased levels of dissociation to sexual abuse by a significantly older person prior to age 15, and dissociation has also been correlated with a history of childhood physical as well as sexual abuse. When sexual abuse is examined, the levels of dissociation were found to increase along with the severity of the abuse.

Dissociation in Everyday Life?
It is very common in talk therapy to ask an emotionally difficult question and watch the subtle posture shift as a client's mind is overcome by a strange sense of numbness, of momentary depersonalization perhaps? I remember one emotionally adventurous client, who likened the experience to the shock of injury.

She recalled having her fingers jammed in a car door, "you know how at first you can't feel a thing," she said while discussing emotional numbing, "its a bit like that, I guess." "Funny how we all use that word you, when recalling personal experiences, instead of I," I said in reply. "A mini dissociation, perhaps?" She said laughing and shaking her head at the feelings beneath her comment.

It seems that only when such numbing experiences become unusually disruptive do we label a common experience as an illness? Even in the official medical model of disease it is well accepted that up to 65% of the population experiences milder forms of dissociation, suggesting a common stimulus within our brain/body systems?

Beyond the perception of disease affected states, other areas of medical research see a bigger picture of dissociation. For decades body psychotherapists have known that trauma and its dissociative affects, is as much about what happens within the body as in the brain. In fact the latest breakthrough in neurobiology confirms that the likely cause of many mental disorders, lies within a poorly understood and unconscious brain/body autonomic nervous system.

Dissociation as the Human Condition?
The human mind is dissociation, without this state there would be no special self awareness for humans? Without the dissociative state we would still be subject to the same instinctive reactions as the rest of the animal kingdom? My own recovery from 31 years of these altered states of mind only came with an education into my neurobiology.

In 2007, when I first started reading the mind numbing pages of academic jargon that describe the human body/brain/mind, I fully expected to learn more about brain disease. I found no specific information on brain disease which might explain my bipolar disorder, yet found a lot of information on how my nervous system affects my brains chemistry.

In short, I came to understand how unconscious nervous system activity stimulates my altered states, my dissociative experiences. With practice and ongoing experience I've learned to sense this unconscious activity by letting go of thoughts, learning to feel the nervous activity of my body, which has its own awareness beneath the conscious mind.

The non disease view of Dissociation?
"Dissociation as a clinical psychiatric condition has been defined primarily in terms of the fragmentation and splitting of the mind, and perception of the self and the body. Its clinical manifestations include altered perceptions and behavior, including derealization, depersonalization, distortions of perception of time, space, and body, and conversion hysteria. Using examples of animal models, and the clinical features of the whiplash syndrome, we have developed a model of dissociation linked to the phenomenon of freeze/immobility. Also
employing current concepts of the psychobiology of posttraumatic stress disorder (PTSD), we propose a model of PTSD linked to cyclical autonomic dysfunction, triggered and maintained by the laboratory model of kindling, and perpetuated by increasingly profound dorsal vagal tone and endorphinergic reward systems. These physiologic events in turn contribute to the clinical state of dissociation. The resulting autonomic dysregulation is presented as the substrate for a diverse group of chronic diseases of unknown origin."
 The Neurophysiology of Dissociation and Chronic Disease Robert C. Scaer MD.

"Most traumatized individuals fulfill the criteria for a number of co-existing diagnoses, which usually include mood disorders, anxiety disorders, substance abuse and dependence disorders, eating disorders, somatoform disorders, and medically unexplained symptoms (Davidson, Jughes, Blazer & George, 1991; Faustman & White, 1989; Kulka, et al., 1990). These complications are reflected in the DSM-IV TR by the inclusion of more than 12 associated features of PTSD (American Psychiatric Association, 2000). The formal diagnosis of PTSD contains three diagnostic post-traumatic symptom clusters: symptoms indicative of intrusive reliving of the trauma, the avoidance and numbing symptoms, and symptoms of increased autonomic arousal. The episodic alternation between the avoidance and reliving symptoms “is the result of dissociation: traumatic events are distanced and dissociated from usual conscious awareness in the numbing phase, only to return in the intrusive phase” A Sensorimotor Approach to the Treatment of Trauma and Dissociation. Pat Ogden, Ph.D., Clare Pain, M.D., and Janina Fisher, Ph.D.

"There is currently an increasing awareness, indeed a palpable sense, that a number of clinical disciplines are undergoing a significant transformation, a  paradigm shift. A powerful engine for the increased energy and growth in the mental health field is our ongoing dialogue with neighboring disciplines, especially developmental science, biology, and neuroscience. This mutually enriching interdisciplinary communication is centered on a common interest in  the primacy of affect in the human condition. Psychological studies on the critical role of emotional contact between humans are now being integrated with biological studies on the impact of these relational interactions on brain systems that regulate emotional bodily based survival functions." An Essential Mechanism of Development, Trauma, Dissociation Allan N. Schore.

While traumatized humans don’t actually remain physically paralyzed, they do get lost in a kind of anxious fog,
a chronic partial shutdown, dissociation, lingering depression and numbness, a kind of “functional freeze.”
Page 52, "In an Unspoken Voice" Peter Levine.

Resolving Trauma in Psychotherapy. With Peter A. Levine, PhD

Our first glance reactions?
At first glance the above links may seem unrelated to "mental illness," and it is important to feel this reaction and ask "is my assumption rational or reactive?" The common link between all mental disorders is our unconscious autonomic nervous system (ANS), which simply cannot be grasped by the mind, it can only be felt. We all have an emotional comfort-zone which is regulated by the unconscious activity of the ANS, and it is the disturbance of that comfort-zone which fuels the reaction to so-called madness.

Watching Peter Levine engage with a PTSD sufferer is an emotional experience for many of us, who have suffered these altered states of mind. It's also an example of the time consuming effort required to bring a new awareness and healing to any individual. Its also uneconomic in our current paradigm of bottom line profits and available resources. As Allan Schore points out, we need a paradigm shift in our perceptive awareness and perhaps an acceptance of current human perception as a basic dissociation would be a good start?

Stephen Porges has introduced a new term for our "at first glance" unconscious reactions, he calls it "neuroception." In his paper on neuroception, he explains the millisecond activity of the ANS as we constantly scan the environment for threats or resources, while maintaining our unconscious comfort-zone. These new discoveries into our hidden motivations explain why we are not as conscious as we like to think, and why dissociation is a common experience and may not be a disease, even in very severe disorders?

RELATED ARTICLES:
Bipolar Recovery
Bipolar Condition
Bipolar Disorder States
Trauma Exit
Bipolar Instincts
Calming Your Bipolar Symptoms
Mania Dreams & the Roots of Psychosis
Neuroception An Unconscious Perception?

5 comments:

  1. Hello, David Bates,

    I just found your blog via a link in one of your comments on Mad In America. I read your "About Batesy" page first, then I read this post, "How do YOU do Dissociation," because it is at the top of the list, in your right hand column, under the heading "Popular Posts This Week."

    You've raised some interesting points and questions. Dissociation -- is it a normal reaction to an abnormal situation? I believe it is. My first dissociation episode happened when I was not-quite-three. We lived in Oakland, California, and my mother worked across the bay in San Francisco Our family had only one car, and most days my parents left together in the morning for their respective jobs, and returned home together in the evening, leaving me with the live-in babysitter. But one day, shortly after my father had given me a terrible beating for not being able to find one of my new slippers that he had "worked his butt off to pay for," he came home alone and told the babysitter to get me ready because he was going to take me along to get my mother from her job.

    I remember how excited, important, and grown-up I felt to be given this rare outing, especially when my daddy told me I could sit up in the front seat where my mother usually sat.

    We were driving over the Oakland Bay Bridge, a huge, towering, intricate, beautiful metal structure. I was gazing up through the windshield (or the windscreen, as you probably call it), watching the overhead beams and cables go flashing by, when my dad suddenly pulled off to the edge of the lane and stopped the car.

    He told me to look out the side window down at the water. I did. I can still see it all so clearly in my memory, the blue-green water far below, a small boat bouncing in the waves, looking like a child's toy, the sunlight shining in a bright path of gleaming gold, hitting me in my eyes.

    Then my father told me that he was going to throw me off the bridge. He said that I would fall down, down, down into the water, and die. He told me he wasn't teasing, the way he sometimes teased that he would throw away my favorite dolls. He was serious, he said. He really was going to throw me off the bridge, he said.

    I did not know why my dad was saying this, why he would do such a thing, or what it even meant to die. I only knew that I did not want to be thrown off the bridge. It hurt to fall, even the short distance from a chair to the floor. It also hurt when I was being given a bath, and water would get into my eyes and nose and lungs.

    When he pulled me from the car, I was helpless to stop him. Traffic was passing us by, zoom zoom zoom, so many cars and trucks, flying past at a dizzying pace. No one seemed to even notice us, there was no way I could call for help. My daddy carried me over to the railing, chanting in an eerie sing-song voice, "I'm really going to do it. I really am. I am going to throw you off the bridge. I'm going to do it right now. I'm not teasing you, I really mean it."

    That was when my first-ever moment of dissociation happened, I believe.
    (Continued on next comment. Blogspot does not like comments that are too long-winded.)

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  2. (Continued from previous comment):
    ….I remember that the first thing I felt, before he pulled me from the car, was disbelief. Of course he didn't mean it, he had to be teasing! The next thing I felt, when he seemed to be able to read my mind and know that I didn't believe him, and so he told me that he was not teasing -- because he was using his serious voice, the voice he always used when he really was going to do a thing, suddenly I did believe him and, in that moment of believing, I felt very small and helpless, and utterly powerless to stop my big strong father from doing the unthinkable.

    That's when I dissociated. When I believed he was really going to do what he said. I dissociated, by going completely numb. Before he got all the way to the bridge railing with me in his arms, something inside of my heart and mind went empty and numb and dead. I felt as though I were already dead, even though nothing had yet happened to my body. My mind seemed to shut down. It was as though my soul had already been murdered, by his words alone.

    At the last moment, I'll never know why, my dad must have changed his mind. He suddenly whirled around, put me back inside the car, and drove on to get my mother from her job. It was my first, and I believe my only time, in that tall San Francisco office building where my pretty young mother worked as a clerk typist. How glamorous she looked in her silky white blouse with the jaunty bow tied around her neck, her slimming black pencil skirt, her glamorous black and white high heels and her blood red lipstick, with her dark hair curling around her face! My mother showed me off to her coworkers, her face beaming when they told her what a cute little girl she had. She took me into a small break room and bought a pack of gum for me, Wrigley's Juicy Fruit, in the bright yellow package.

    I chewed the whole pack of gum on the way home, sitting alone in the back, listening to the drone of the car's engine, the tires swishing on the pavement, the quiet, homey sound of my parents sharing tidbits about their day. Although I could taste the gum, I could see the lights coming on as the sun went down, I could hear the sounds all around me, inside I was still numb, still feeling as though I had been murdered on that bridge.

    My dad never spoke about it, and neither did I. At not-quite-three, I lacked the vocabulary to say anything to anyone about what had happened. My father probably thought I had forgotten it in time. But I never forgot. I had nightmares for years about falling down down down into a blue-green sea. And I have never been able to drive across a suspension bridge, or see an ad with the bright yellow pack of Wrigley's Juicy Fruit, without living through it all over again.

    "Caren"

    PS: I remember that you were an FB friend of mine, before I ended my account there just over 1 year ago. I was bullied, bashed, and shamed off of FB by several members of my family of origin, much-younger siblings and a couple of their now-grown children who do not like that I am finally telling the truth, as I remember and understand it, about my own life, most of which happened long before any of them were born. Though of course they know better than me, the "crazy big sis," what REALLY happened in my early childhood.

    I hope you are doing well. Are you still in Thailand? My real name that I used on FB starts with the letter "L." I am married to the guy I call my BFH, for Best-Friend-Husband, if that rings any bells. I'm just very tired of being the target of ignorant haters, that is why I now use a pen name. Caren, for CARE: Compassion, Acceptance, Respect, and Encouragement.

    Most bloggers do not seem to care for my long-winded comments. I have a feeling you will not mind. I hope I'm right! Blessings~

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  3. Hi Caren,

    Its certainly a gut wrenching story of brutal emotional trauma. Dissociation is our oldest defense against pain, be it physical or emotional and its less acute form is denial, like the denial of your family members who cannot face the brutal and shameful truths about life.

    As with my own family there is a need to rage against and shame the truth teller (shoot the messenger), because like dissociation, rage is an unconscious defense against feelings of shame.

    We cannot "feel" rage and "shame" at the same time, its a physiological impossibility, and like my own, what your family, members are defending themselves against is not you, but their own "unconsciously" stimulated sensations. Their need to not feel the shame of a reality which all families react to by insisting on secrecy, an action avoiding the brutal truths of reality by suppressing awareness by denial, a form of dissociation.

    Your writing is great Caren and I encourage you to continue writing as a form of self-therapy, where we slowly, slowly, unpeel the union of core sensations within the body which threaten to annihilate the conscious mind.

    Trauma, both physical and emotional, is being increasingly recognized as a root cause of mental anguish/illness and I personally believe that we are turning an historical corner, so to speak, in recognizing the "unconscious" stimulation of so-called normal and abnormal reactions to life. As you rightly suggest, dissociation is a completely normal reaction to a brutally abnormal life circumstance, it is not pathological!

    Only a constricted sense of self, such as the academic intellectualism which lacks any real, raw-life experience, could so disgracefully judge another human being as faulty, because such intellect lacks awareness of its own stimulation, including its need to judge others.

    I guess from your writing that you've accepted and are increasingly coming to terms with the reality of so-called family and its need to judge you as bad for speaking about truths the family would prefer to cover-up and habitually shy's away from. Its a difficult road to hoe in life, yet it is high time that the game playing denial of so-called normality was challenged to face up to itself. Those of us who suffer normality's slings of outraged indignation know only to well, how false a normal sense of so-called reason can be, a tower of babel built on an unconscious need to deny.

    I hope your taking care of yourself and doing well, and that you may have found your way to the kind of healing "body-psychotherapies" like Peter Levine's somatic@experiencing can offer victims of trauma, and release from a life of, "the trauma trap" http://www.bipolarbatesy.blogspot.com.au/2012/12/madness-chaotic-energies-of-trauma-trap.html

    Best wishes,

    David Bates.

    P.S. I'm now living in Sydney Australia, where my healing journey of self-discovery continues, along with the denial needs of my own family.

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    Replies
    1. Thank you for your very kind reply, David.

      I do have at least one book by Peter Levine, waiting in my towering pile of to-be-read books. For the past 5 months, since I learned that my 15-year-old granddaughter is expecting my first great-grandchild - he is due in about 2 weeks -- and I also, around that time, got the heartbreaking news that the family trauma and madness I gew up with, has been handed down not only to my adult children, but also to my children's children, regardless of everyone's determined intention NOT to pass the insanity on -- since these things were brought to my attention, I have been on what I call a "Madness Marathon," reading and searching and trying to figure out what, exactly, is wrong in me and my family. Is it biological, genetic, environmental, trauma based, a combination of these things, or... what?

      At this point in my searching I tentatively believe that it is all, or almost all, trauma based. On both sides of my family tree there are all kinds of mental illness labels: schizophrenia, Multiple Personality Disorder or MPD/DID, Bipolar, Post-traumatic Stress Disorder, various personality disorders, and addictions of all kinds. But I believe that every one of these emotional/mental problems is rooted in some kind of trauma, which has been passed down through the generations like a curse.

      How far back does the insanity go? Probably forever. I dabble a bit in genealogy, just for fun, and have recently made an interesting discovery: a great x 8 ancestor of mine, whose parents were Puritans that sailed from Lancashire, England, and landed on Plymouth Rock in 1623, abandoned his wife and children in the late 1600s and ran away with a married neighbor woman. For this "crime," the married woman who had abandoned her own family and "enticed" my great x 8 grandfather away from his wife and children, was publically flogged 15 stripes and fined 5 pounds.

      Meanwhile, the wife who had been abandoned, my great x 8 grandmother, died in childbirth. Then HER father, in a furious rage over the way his son-in-law had treated his daughter, took the children into his home, rather than allow the father who had abandoned them to raise them.

      There are more insane twists and turns that I discovered to this ancient story, but I won't bore you with all of it. My point is that there has been "dysfunction" in my family going back at least 400 years, and that's just on my mother's mother's mother's branch of my family's tree. My dad's father was half-black and half-white, the grandson of a slave and (probably) a slave-owner, born around 1910 when the segregation laws here in the USA were fully in effect. My grandfather, with his blue eyes and light skin could pass for white, so he ran away from home at age 13 and was on his own from that point on, drinking alcoholically to medicate his pain. He adandoned my grandmother, his first wife, when she was pregnant with my father, and I have often wondered if part of the reason may have been because he was afraid that my father would look like an African-American, and his secret would then be exposed. My paternal grandfather went on to marry and divorce several times (as I have done). His last wife, a nurse in a psychiatric hospital, committed suicide within a few months of their marriage.

      It seems to me that the human race as a whole is mentally ill. Those who are the sickest are, I believe, the ones whose denial is the strongest. When a truth-teller like you or me comes along and tries to shake them out of their denial, I suppose we shouldn't be very surprised when we get denial, lies, and rage in response. But it's sad, isn't it?

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    2. By the way, David, as I was reading more of your background story here on your blog, it occurred to me that you would probably get a lot out of one of the books I've recently read. It's written by therapists, for therapists, and it's priced accordingly. But this book is worth its price several times over, in my opinion, because it explains so much! Particularly, I think, about the kind of family you grew up in which, by the sounds of it, was much more covert than overt like mine. This book is now one of my top 3 favorites, of the literally dozens of therapeutic books I've read. The book is: The Narcissistic Family: Diagnosis and Treatment, by Stephanie Donaldson-Pressman and Robert M. Pressman. Here is a link to the ebook version on amazon.com (which, if you don't have a kindle reader, can still be read via a free kindle app that you can download from amazon to your computer):

      http://www.amazon.com/The-Narcissistic-Family-Diagnosis-ebook/dp/B0028N60UQ/ref=sr_1_2?ie=UTF8&qid=1360313278&sr=8-2&keywords=the+narcissistic+family+diagnosis+and+treatment#_

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